Intensive care unit admissions in Federal Medical Centre Umuahia south east Nigeria.

BACKGROUND: The Federal Medical Centre Umuahia (FMCU) is a tertiary referral centre in Abia state, southeast Nigeria serving a catchment area made of Abia state and environs. An intensive care unit (ICU) was established in the hospital in December 2009 to improve healthcare delivery to critically ill patients. OBJECTIVE: To determine the admission patterns and report the initial experience in the intensive care of patients in the FMCU. METHODS: This is a retrospective study ofthepatients admitted into the ICU of FMCU from December 2009 to March 2011. Data retrieved from the patients ICU records included demographics, indication for admission, length of stay in ICU, and outcome of stay The cost of ICU care was extracted from the financial records of the patient following discharge or demise. Data acquisition and analysis was performed using the statistical package for social sciences (SPSS) version 15. RESULTS: A total of 87 patients were studied consisting of 59 males and 28 females. The ages ranged from 2 days to 87 years with a mean age of 41 +/- 2.34 years. There were 11 patients within the pediatric age range (12.6%). Post-operative surgical patients (51) accounted for the majority of the admissions (58.6%). There were also 21 non-operated trauma cases (24.1%), 7 medical cases (8.1%), 8 obstetrics and gynecological cases (9.2%). Post-operative admissions were mainly emergencies--39 cases (76.5%) cases while 12 (23.5%) were elective. Most post-operative ICU admissions followed abdominal surgery -31 cases (58.8%) while neurological trauma accounted for most non-operated trauma 17cases (81%). The cost of stay per patient ranged from N2745.65 to N238123.4 ($82.23 to $1536.28) with an average cost per day of N19506.75 ($125.85). The cost per day for mortality cases was N28598, 74 ($184.51). The modal length of ICU stay was 2 days with a mean of 3.63 +/- 0.34 days and a range of one to sixteen days. About 68.4% of the patients spent = 3 days (38.3% of total ICU days), while 31.6% spent > 3 days (61.7% of total ICU days). Of the 87 patients, 57 (65.5%) were discharged from ICU to the wards, 28 (32.2%) died in ICU while 2 (2.3%) were referred to bigger centers. Twelve mortalities (42.8%) were among the emergency postoperative patients and 10 (35.8%) non-operated trauma patients (80% of which are neurological trauma). CONCLUSION: From our study, most ICU admissions and is comparable to other studies in Africa. The cost of stay is very high when compared with annual per capita income in Nigeria of $1190.

Profile of paediatric umbilical hernias managed at Federal Medical Centre Umuahia.

BACKGROUND: Umbilical hernias are common in children but many resolve spontaneously within the first five years of life. Most umbilical herniorrhaphies in our environment are due to symptomatic hernias which constitute a small percentage of all umbilical hernias. PATIENTS AND METHODS: A retrospective review of all pediatric patients with UH treated at Federal Medical Centre Umuahia, Abia State from February 2001 to February 2011. RESULTS: There were 22 patients but only 20 of the folders were found and analyzed. They were made up of 11 males and 9 females with a mean age of 6.19 +/- 0.83 years and median age of 6 years. Nine(7 males and 2 females) had acute incarcerations, nine (3 males and 6 females) had recurrent umbilical pains without incarceration and two (1 male and 1 female) had recurrent incarcerations. Age range for acute incarceration was 2-8 years (mean: 4.69 years, median: 4 years); recurrent umbilical pains was 4 months -15 years (mean: 7.7 years, median: 8 years) and for recurrent incarceration 2-10 years (mean: 6 years). All had standard umbilical hernia repairs except one whose parents declined surgery after reduction of acute incarceration. One patient with acute incarceration had gangrenous bowel with hernia sac abscess and was offered bowel resection with end-to-end anastomosis. On short-term follow-up, the symptoms resolved in all the patients following surgery. Five patients had six complications: 1 exuberant granulation tissue, 2 stitch reactions, 2 superficial wound dehiscence and one superficial wound infection. There were no mortalities and no recurrence on short-term follow-up. Only one patient (5%) registered under the National Health Insurance Scheme (NHIS). CONCLUSIONS: Active observation of all umbilical hernias at all ages will ensure early detection of complications and prompt treatment. Elective repair of umbilical hernias in patientsabove five years with fascia defect greater than 1.5cm is encouraged. Comprehensive NHIS will ensure early presentation and reduced complications.